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HomeMy WebLinkAboutBLACK RIVER CAVIAR - RETAIL FOOD Black River Caviar 3821'Fahnouth Rd.M.Mills OS9-604 i i t t k . y .. e , > f Ss .. A, 0k � le it 2 , a s FORMERLY: CHUKULA.TI'S. / Utlt3' 3A. + s Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. RARNIM M. F.P.(Thomas)Lee, Mms& Daniel Luczkow,M.D. Alt. $ .639. 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 1132 Issue Date: 01/01/2022 DBA: BLACK RIVER CAVIAR OWNER: BRCNA LLC. Location of Establishment: 3821 FALMOUTH ROAD - UNIT 3A MARSTONS MILLS, MA 02648 Type of Business Permit: RETAIIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2022 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE- ICE CREAM: GQ� FROZEN DESSERT: . Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE i Restrictions: i 04�Nxgy, Town of Barnstable BOARD OF HEALTH �La John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAMNWABLL - F.P.(Thomas)Lee 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D.,Alt. ''r�ana Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1132 Issue Date: 07/22/2021 DBA: BLACK RIVER CAVIAR OWNER: BRCNA LLC. Location of Establishment: 3821 FALMOUTH ROAD- UNIT 3A MARSTONS MILLS MA 02648 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2021 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE- ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: f OF�HE 1p� Town of Barnstable� For Office Use Only: Initials:o ^ Date Paid Amt I'd$ p anxxsrasr.E, Inspectional Services � v ' ASS 639. Check# Cash i ♦0 Public Health Division ptfD MAC s Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 07 23.2021 NEW OWNERSHIP X RENEWAL NAME OF FOOD ESTABLISHMENT: BLACK RIVER CAVIAR (BRCNA,LLC) ADDRESS OF FOOD ESTABLISHMENT: 3821 FALMOUTH RD 3A MARSTONS MILLS 02648 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: SARAH.MAY0p_BRCAVIAR.00M TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (_774__)_810_-_5418 TOTAL NUMBER OF BATHROOMS: 1 WELL WATER: YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:—X SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE _X_RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 OWNER INFORMATION: https:Hd.docs.live.net/c250064431997328/DesktopBRC/5 Admin/Permits^0 Licenses/Marstons Mills TOWN Permits[FOODAPP 2020_MARSTONS MILLS.doc I FULL NAME OF APPLICANT SARAH MAYO SOLE OWNER: YES/NO D.O.B 01/03/1962 OWNER PHONE# 774-810-5418 ADDRESS 3821 FALMOUTH RD, 3A, MARSTONS MILLS, 02648 CORPORATE OWNER: EDWARD HERRICK CORPORATE ADDRESS: PO BOX 2675, TELLURIDE, CO 81435 PERSON IN CHARGE OF DAILY OPERATIONS: SARAH MAYO List (2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. _07 /_23_/_2021 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbirnstible.us/healthdivision/applications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3111 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc I � 1 I i h I R ztl• i i t it 4 45 1 1 xgY �y � pill • �a J-N v - t 9..4 ` ,} _ fil J•M b y gs t M rJ•N •+�•at ��C ! u Y f rri � JY 31, y i t ~ L w R �Iq J4 0 30' (hallway) . RETAIL SPACE ENTRANCE UP 'TOR S \ T a FREEZER A 20' I R FULFILLMENT OFFICE SPACE S REPRGC ROOM DOWN 1,:AWASHING HAND WASHINGINK SINK y 12R y3 3 Th�NEESeAY SiHK R GROUND FLOOR (STREET) MOP & STORAGE GREASE TRAP 3821 FALMOUTH RD, 3A ROOM INTERCEPTOR MARSTONS MILLS, 02648 { , Town of Barnstable BOARD OF HEALTH 'l•� John T. Norman Board of Health Donald A.Gaudagnoli,M.D. tnxsrSM. Paul J.Canniff,D.M.D. o 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee,Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 1132 Issue Date: 01/01/2021 DBA: BLACK CAVIAR OWNER: BRCNA LLC. Location of Establishment: 88 FALMOUTH ROAD HYANNIS MA 02601 Type of Business Permit: RETAIL FOOD Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2021 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -------- ----- -- -- -- MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: F, oFtHE r�� �•Office Use Initials:•�"�. Town of Barnstable . Date Paid �3 ' Amt Pd$/0 + &MMSTABLE. : Inspectional Services / v MASS' Check#pEE039.e`� Public Health DivisionCVhp Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 3 NEW OWNERSHIP RENEWAL ((3ecNo- NAME OF FOOD ESTABLISHMENT: 3�j��_(� `��-� L(,w' �✓ V O�y ✓ � L L� ADDRESS OF FOOD ESTABLISHMENT: 0 0 1:�aVYL(T11+1.-c U2 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 07 &/1/I>°i/S E-MAIL ADDRESS: e— 6(—C.LV,-A,a,Y. Cd-, TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO --� ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: --Q� TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: "" �� FULL NAME OF APPLICANT tjyjoL u SOLE OWNER: YES/NO D.O.B OWNER PHONE # 6 ZS' 2-02, ADDRESS_ POdJ D� Zb (�� lA✓ f l O t-I )� CORPORATE OWNER: I�LC, CORPORATE ADDRESS: PO &V X PERSON IN CHARGE OF DAILY OPERATIONS: J�ji�G�tr- 0 List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. �,VlK / / 1. I V 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at httu://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:Wpplication FormsTOODAPP REV3-2019.doc Bellaire, Dianna From: Crocker, Sharon Sent: Monday, April 05, 20214:05 PM To: 'sarah.mayo@brcaviar.com' Cc: Soto, Kathryn; Bellaire, Dianna Subject: Black River Caviar, MM Attachments: FOODAPP 2020.doc;VARIREQ Grease Trap 2021 3-1-2021.docx;VARIREQ Rev 2020 9- 2 2020.docx Sarah Mayo Black River Caviar 774-810-5418 Location: 3821 Falmouth,Windmill Square, MM Attached is the food application. The Board of Board meets once a month - next two meetings: April 27 -Submission due by April 13tn May 25 -Submission due by May 11tn See attached Variance Form for required paperwork, 5 packages collected of each submittal, along with the $95 variance fee. Also, attached is (1) the Variance—Grease Trap, and (2) Variance—(all others)...in case you need other variances. I do not know what variances you will need. Please contact with your inspector. The seating will be worked into a calculation of the septic design and State Code. Your inspector will be Kathryn Soto, EMAIL: Kathryn.soto town.barnstable.ma.us Regards, Sharon Sharon Crocker Office Manager Town of Barnstable—Health 508-862-4739 ]:Ire infor..tnation.contained..in this electronic transrri.ission ("e-.rna.il"},including any attach.nient(the"Information"),tnav be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work..product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.lks such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public I Iealth and,/or the Town.rkttorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or fonvard it.Thank you for your cooperation. 1 i 6E � Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSTABL& Paul J.Canniff,D.M.D. MAC 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 1132 Issue Date: 10/15/2020 DBA: BLACK CAVIAR OWNER: BRCNA LLC. Location of Establishment: 88 FALMOUTH ROAD HYANNIS MA 02601 Type of Business Permit: RETAIL FOOD Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2020 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - - -- -- MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I �fZHE 1p� For Office U • Initials: � o Town of Barnstable �p IS � � 11715 Date Paid Amt Pd$ i;,i�.'YSTpBLE. : Inspecti©nal Services /� ASS. Y3 ,.1 c Public Health Division Check# GJ� t] iDrfa nnn'� Thomas McKean, Director 311- OW 200 Min Street, Hyannis, ALA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 14 October, 2020 NEW OWNERSHIP X RENEWAL NAME OF FOOD ESTABLISHMENT: BRCNA,LLC ADDRESS OF FOOD ESTABLISHMENT: 88 Falmouth Road,Hyannis MA 02601 - MAILING ADDRESS(IF DIFFERENT FROM ABOVE):14 oa eu c 4ao-e-, eeeL�� E-MAIL ADDRESS: sarah.mayoAbrcaviancom TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 774 )810 - 5418 TOTAL NUMBER OF BATHROOMS: 3 WELL WATER: YES NO x ... (ANNUAL WATER ANALYSIS REQUIRED) L�-s7 5)1 ANNUAL: SEASONAL: x DATES OF OPERATION: 18/10/20 TO 01/04/21 NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)9 —dj-- TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE X RETAIL FOOD-ONLY required for TCS foods (foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 OWNER INFORMATION: C:\Users;Saral\Desktop\BRC15_ADMIN\Falmoutli OfticeTOODAPP 20N.doc I 4 FULL NAME OF APPLICANT Sarah Mayo SOLE OWNER: YES/NO D.O.B 01 March, 1962 OWNER PHONE # 774-810-5418 ADDRESS42 Phinneys Lane,Centerville MA 02632 CORPORATE OWNER: BRCNA,LLC (Black River Caviar) CORPORATE ADDRESS: PO Box 2675, 117 N Aspen St. Telluride CO 81435 - PERSON IN CHARGE OF DAILY OPERATIONS: Sarah Mayo List(2)Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. *ATTACH COPIES OF CERTIFICATES" The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. 2. i' l I Toav of Barnstable I\�� Public H lnxpecliDnal ServiceR I:.,...Id-.�,:.a3_ ealth Division Tbmmu A1cKcvm.Dime + 2Ui Atin S:rru,I ha:nuL IIA^:2AU1 .`w <VfvwSra..ln l(1 Yn.Wx.MwrN A UA Nbx ON NIMs IP�_RI.VEx'AL_ NIAIW,N'OADDREP.111DIFFFREN TFRMIABOVEI;,,,,,,,,,,,,,,,,_._._�__..__.�_„__.._...... TELEPHONE?'ULIBEROFFWUEf—LIA....T:1}j�Jpj�-YIA TOTALNI:— OTPATHR—li_j_ tt61.I,SA'ATFAI:VE.c ,NO_A_...IAN'NI!At.VV'ATEP AN"ALV'SIS REQVIREDI NDmtlEx OF SEAI R:IhRIDE: HI:I SINE: 'ITYI'AL: U ABATING:A1l!S'I'OBTAIN'A C:OAIAION VI(:Tl11LLY.l<'S 1.If:ENSI.FHOM I.ICEY51:\C:UIV. REOISRf.MEN'i5. N"AITBTAFF P0.OVIDED POe MTSIDF.DIN'INf.?_ "A', R AN AIR rkRTAIN PROVIDED AT SS'AITSTAFF SERA'IEE MORIS)'_ JYVE OF Ea'FABLISHMEh'I':(PLEASE CHECK ALL THAT APPLY BE—) _1. SF.—F X-RL'MILU Odll:U:i'LA'rmlrimd Fvr'FC'S—I—..—RrfAR..NIo.:n..arrl C'VI�I',w�FVVUI uV>Txr 1[vrmrny.Namn•I ABrIwv1 MOBILE FOVD EVI E5 A ISEE 5..,(.NONTNI.Y I.AR ANA I Is.P ) _CATFJUAG'(C-iTERIHCA'oTICE REQL:IHEo B[fORE ' PACE Ii) •"SEASONAL.MOBILE.S SF,H'FlN)U O:Vol1 FI uSPx` IIaNER 11Pf1R11A1i0,1: FLLLNAMEDFAPPWCASI_Snnh Nful .SOLE V55'NEA:YEN'NO v ry Z.Dl MAreh,1%2 OWNER PHONEY 774-810,N� COHPORATE ADDRUA Vf1 A 9m•1 V -5 11 .S A.,e S[, T01,6d, CO 11435 IF-1 IH rRLAROE aF OAnv...ATI-1;Svmh Mavu Lin(2)Certified Fund PmNm.M—g AND It 1-1(1)ARer]t<•n Awurrnme C-dr.dSINT An FOI)11 FSTAH ISD Af EN IS mnN III,I Cr1'dRM FOM VlDterdon MAnngrr PER SI I IFT. "ATTACH COPIES OP CERTIFICATES••TM1r 11<vllh Div'.HillT urr Pvst)'Fen'rrculW.You uN provid<mv CPMIkd Food M n,i,o vndMF.TDirAdon DaTteS Fl 1 Ywr Im d M-men Aw n eNvbii WIDmIl \/ SIC.S.AITIRE(IF APPLI— DATE ...FOOD POLICY IN'FOR,NIAI IDN••• 6E.tiONAL 4•JOUSLRV'IC'L Ali w.wkl faW M.LB.bmcm4 iodu:3aP vuhde marls vrvN L ivyarci H IM YIaM1AUiv. v ik.n.ell llullh lh,.o:fba.u..uNlmwMl.y mmrxu:n.mar.mllmtn..i]Idnvin advvnn. OEENDAUNDESSFR25:FviA Jr.unr mm:Aw.uWgnSm:etwiH.J WEpiur luupmivP rnJ:Aum3lr psalm. w•1'krc•ck.v:nmh:mlv.IIR IIOI:F i)n.Fo:h.:v ruM u.✓m rcv:h in lA. P:nnv n.:wmn:,l u.•v f'nrrtnllnvi Itm.:.wil:Lv dvn.:.+a.w.uu. C.STCPI.N'c POCI['SN.>n vilho:UaTvnv ul[km,uFk umr:nud:Y!L.T.•uu FY fi+a v:vil)+im l.ua-iuy nm..lnu:nuac mnNeaol F uc l.mnA v:hl n OITDOOR[[NJRFNY;:tAwinmrnkiny Prepvainv,m JiNluv of eny I:.Nlvmlmi by v fmNrusMiNursm.,Prn6Rikd. VUI'IC'E.R'urvvwnu.lh Aw:Jrnumylnm M.JI•msh sx'snAm)vv:.RIS A'OUP xESYOYSIBILi'IV 10 RI.T;PN T)IR'nN1!'I.ETii:AITI.ICATION'I5:ANT PFIN�mLD TCC�tll'Oif.Iv MAIL-IN RLQLJL$IS Plcaae mail the rnnlpleled mi.,ulion I,tO II a-1 helow,.11xo include:rlpic of ynur empicyeI. r Vl I,—)IN: ili., ngeatie,mr,w d nN--tI—f.rrgeu my cc wte(m IraU une.)In addilim•plea I i:rclude 61 s g,dd l fce amount(.ee fves a bunom of This Pay),Make rha"k pay':sblc lo:Tc-wn of Rumsmble.Ou'meililig Addrry iJ: TnDu of BamR•hlr P.Mi,IIceIIb EHTUIon 300 Al I.Siree[ Ilpam 1,MA W.1 FOR FAXED REOUECTC Our h,n:onber Is(308)7% 0,1.Pleme faa A comVleuM apph wdon CDnn.Also,plruc lus repia of YOur mnpl,—,lix.l plmce[iun mm�ager veining—,ifwle5(AI 1—1—)and fi s ollOyen uwurrnr.s Irdining rdhcme(nt ue.)In mldidun.)vu must mail the srynucJ fce Iml(ue bu5 Celpw).pl—make the ,1-,P y blrrto��l�own of N¢rnslRble.The check mm�be nuikd sn the addrca lissrd abm'e. FEES:Drd6 Brcakf¢st PeDvit-LS:Fswd Surire.Permit 0-19 uan-S3.SQ;5U[A mnra stun 35M; 1 Cnn[inullal 6iza11'mI-f10',Reuil Posh lunIY TCS FumIT)-f20;Retell food Slom Lessd1W RON)S.F.- i$IN m::I,dlan S,NE NF_-S285;IEas Illan I_N S.F.;Reuil F,.0 C,,WI-Lilllilul Prep.-52w w,C:mt.p Pwd IudusVY-3]5,N1ubiL SIueL-350.MW:ilc Irc Csrvu TmAI-315.fwuU 0.ss,:ll Liu'use.-3)0. .Add pao-rcPoMnbk fn[otN:c'Csublisbmcm os h'mv ou'nttsldp=510653(I(Ys.<smfD.Lalc Pce= j SIo . ,-Bel.faire, Dianna r Qw , co � From: Flynn, Margaret DO . (A o%_nq,, Sent: Tuesday, October 13, 2020 10:19 AM e To: Bellaire, Dianna b0. (� {le>� Subject: RE: Formal Site Plan Review - 10-15-2020 u.Q.e uivr eL MAZ Dianna, They are approved,give Sarah Mayo a call at 774-810-5418.Just doing retail at this location for 6 months. Maggie �Qrez� • rnoL 0 Oyn �Q��EIOPMf�r0, lMaggie Flytnl z ? rA $ Permit Coordinator I Planning& Development 5 = Town of Barnstable 1200 Main Street I Fiyannis, MA 02601. margaret.flynn@towr.barns:table.ma.us P 508-962-4679 Due to the pandemic,Town offices are currently not open to the public, but staff is available remotely and meetings-fie being scheduled by appointment only. From: Bellaire, Dianna Sent: Tuesday, October 13, 2020 10:14 AM To: Flynn, Margaret Subject: RE: Formal Site Plan Review - 10-15-2020 Maggie, Is Black Caviar open? I haven't received any application from them and David said they would be applying. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure. It is for.the addressee only.This Information may be privileged and confidential.work:-product or a privileged and confidential comma-mic:ation.The.Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The.Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town-At:torney's Office of the'Town of Barrisrable. If you have received this e-mail by mistake,please notify the sender and delete it from Your system.Please do not copy or forward it. Thank you for your cooperation. From: Flynn, Margaret Sent: Tuesday, October 13, 2020 9:13 AM To: Anthony, David; Barrows, Debi; Beaudoin, Griffin; Bellaire, Dianna; Brigham, Anna; Capt David Webb; Ch18Requests; Maruca, Joe; Winn, Michael; Rhude, Paul; Collins, Nathan; D Paananen; Deb Krau; Deputy Chief Rick Fautz; Duffy, 1 Beifaire, Dianna From: Stanton, David Sent: Tuesday, September 29, 2020 3:40 PM To: Desmarais, Donald Cc: Bellaire, Dianna Subject: Black River Caviar, 88 Falmouth Rd, Hyannis Donny, Just a heads up,there may be an application coming in for said business\address. Per the applicant, Sarah Mayo, it will all be packaged caviar for retail sale. They will not be having open product\repacking. She stated it does require refrigeration, so they would need a retail food permit. I also told her to consult with the State if she needs a license with them (possibly wholesale) Thanks, Dave 1 BIKE TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name:,�V 09A �y Q-Nr- Date: 1 L�,ge: - of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. SrARLE. ° 200 MAIN STREET 3:30-4:30 P.M. BARN STABLE. MON.-FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p •6sm p.0 HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FON1P� F D ESTABLISHMENT INSPECTION REPORT Name Date )� o Tvpe of Inspection Operation(s) Routine'' Addres Risk Food Service Re-inspection Level <WDPrevious Inspection Telephone Residential Kitchen Date* Mobile re operatio' Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Miolations Related to Fggdborne Illness Interventions and Risk Factors(Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective Action as determined by the Board of Health. 590.009(E) ❑590.009(F) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �p ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals lam' FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ` ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations L�� Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or 16�xb Corrective Action Required: o ❑ Yes within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ C N Official Order for Correction:Based on an inspection today,the items Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency.Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. if no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violatio han 4npn-critical. If no critical water,sewage back-up,infestation of rodents or insects,lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address a i ob to on ritical violations=C. refrigeration,or no PIC or alternate PIC present. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: nspector's Sig re nnt: 31.Dumpster screened from public view Gil . Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Prin. Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N d' � _... ---ter-...v-.,� a-•. _- - �,rm.';a-�• ._...:�...�---„R�.,,..--.-.�.•rn.� �e � �_ -�- -. -o .. � ... � Violations related to Foodborne Illness r Violations Related to Foodborne Illness Interventions 9 Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* B Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) I Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information'-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 1 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 7-201.11 Separation-Storage* } 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Chairge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* � 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* ! 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* _Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY g 3-401.11A(1)(2) Eggs-I55°F 15 sec 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 590.006(B). Water rieets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* 3 401.11 B 1 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source ( )( )(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency r f ces of Equipment* of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish an*Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfi.&* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) ' Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands an Arms* d A * Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shelkstock Identification Present* 2-301.12 Cleaning Procedure* 165°F*, foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g• g g 3�03.11(A)&(D) PI-IFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B).- Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) * 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstoek 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shel(stock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention t3'� p s 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* ` 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. � r Op THE Tpk, TOWN OF BARNSTABLE _ HEALTH.-INSPECTORs Establishment Name: � � � �Qr Dater 'Z3 ?i�- Page:,L_of I 6 OFFICE HOURS �AR E PUBLIC 2 0 MAN STREET -- - - ' 3:30-4:30 P.M. : 0- :30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. •� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �A .a3v a 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT S i Name (��C 4;Vt.__OR 61f Date?/,,,I?d Type of Type of Inspection 1 Operation(s) Routine ( rid Address 2 M Risk Food Service Re-inspection _ z-I `�6- ' ` Level et + Previous Inspection Telephone. esi ential Kitchen Date: qrl Mobile re-ope a i Owner HACCP Y/N Temporary SU9P­eRcTTllness Caterer General Complaint Person in Charge PIC Time Bed&Breakfast HACCP Yr in:3 Vol Other Inspector p Out: v L Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ �3 L-" -tit42 vocl, Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands A I Z 1 •I ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 1V L +Y; ? Estes of EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 1 FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) in ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating tu LA,c ko ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling t ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ` U ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) J / ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY / ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories �e (/G�.f !/L7q[ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 17 Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: I Y s Non critical(N)violations must be corrected immediately or Overall Rating 1 within 90 days as determined by the Board of Health. Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g Emergency Closure Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than n-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit'and cessation of food establishment operations. If if no critical violations observed,4 too 6 Hon-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i cal violations. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8Hon-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector' Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ..,:,--n-:.aa.+n-,.--_y...�-.-.-.._-`^-----s,...-•.`.ti ...+. --._ ... ..y _.......-r.�_.._ _r_�...:.-.�.,...r..�-.f.-...t.,.�.-..., .f�.._�.,. ,.-,.. .. �. -.� � . _ -.. -. ..-.-�. .. .-.. -. .....:. s.e-...ri ...a.: _.w^,e-s-:« _., - ...._.,,-. ,.- .. _ . ., a ..._. ..-..�.... _,.., .-. . Violation related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* *- 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 1S Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained A[or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH -- 3-302.11(A)(2) Raw Animal Foods Separated from Each. _ 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2_ .590.003(C) Responsibility.of the Person-in-Charge to _ - 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F Separation-Storage* Applicants* - - - 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person.in-Charge* _ _ 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR - _ 3.306.14(A)(B)Returned Food and Reaervior of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources' 9 _ Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13- Fluid Milk and Milk Products* - - 4_501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 4601 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-ImmediF 15ate secte Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System*. - .11(A) Clean Utensils and Food Contact Surfaces of Eggs-Imme Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef°"ve 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* V ' ' 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or . . 3-201.15. _.Molluscan-Shellfish from NSSP Listed _. _ . _ Chemical* g g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P -- -Game and Wild Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority pp y 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* - "- - 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.0.04(C) L Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 ` -- - Redeiving/Condition' - - - 2-401AI Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11___ PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403,.1l(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES i * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 7 8 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14 13 Handwashing Facilities Cooked PHFs from 140°F to 70°F (A) Cooling * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 301 (hallway) RETAIL SPACE ENTRANCE UP �REFli3E ATC y '1.:1"'c1�Va y ` F�tEEZER� A �aR 20 R FULFILLMENT OFFICE SPACE S ROOM REFRIGERAfiJ r DOWN . HAND WASHING SINK HAND WASHING SINK INKu f. �-F.x.. GROUND FLOOR (STREET) MOP & STORAGE INTERCEPTOR 3821 FALMOUTH RD, 3A ROOM MARSTONS MILLS, 02648 f Closet 4 p 2 ..- �..w..x•er ... ..n......rn. �i ar.. tT. 'sC.M ro4"a Rc+:'F.. i UP dry fod storage shWlu�x�gY A T I STORAGE ROOM R S z e BASEMENT 3821 FALMOUTH ROAD, 3A, MARSTONS MILLS 02648 APPLICATION FOR SITE PLAN REVIEW * GP or WP areas restrict wastewater disc arge to 330 gallons per acre per day into on-site system. LOCATION: Business Name: BRCNA,LLC(Black River Caviar) Assessor's Map# 057 Parcel#004 Subdivision Plan Property Address:3821 Falmouth Road, ANR Plan Marstons Mills 02648(Building 2 on Site Plan) Site Plan OWNER OF PROPERTY Q(.� Name: Stuart Bornstein,Holly Management APPLICANT n ,� Address: One Financial Place,Building 1 Name: Sarah Mayo Suite 121,297 North Street Hyannis,MA 02601 Address:92 Phinney's Lane Telephone: 508-775-9316 Telephone: 774-810-5418 Email:tbusby@hollymanagement.com Email: sarah.mUo@brcaviar.com ARCHITECT/DEVELOPER/CONTRACTOR/ENGINEER AGENT/ATTORNEY Name: Name: Stuart Bornstein Address: Address: Same as Holly Management Telephone: Telephone: Email: Fax: STORAGE TANKS(HASMAT/FUEL OR WASTE OIL) ZONING DISTRICT CLASSIFICATIONS Existing n/a Proposed n/a District_VB-A_ Overlay(s) Number n/a Number n/a Lot Area_ Sq.Ft. Ac. Size Size Fire District Above Ground Above Ground Setbacks(ft.) Underground Underground Front_ Side_ Rear_ Contents Contents Number of Buildings Existing 11 Proposed 0 Demolition UTILITIES Sewer-Public_ ❑ X Private Size gal TOTAL FLOOR AREA BY USE: Water-X Public ❑Private Basement Existing(So.Ft. Proposed(So.Ft). Residential Electric-X Aerial ❑ Underground #of Bedrooms Gas-X Natural ❑ Propane Restaurant Retail Grease Trap X Size Under Sink gal Office Sewage Daily Flow * gal Medical Office Commercial (specify)_ 1500 unit Wholesale(specify) PARKING SPACES CURB CUTS Institutional(specify) Required Existing Industrial(specify) Provided Proposed All Other Uses On Site On-Site To Close Gross Floor Area Off-Site Totals Handicapped I — 1 Old King's Highway Regional Historic District File# Approved? ❑ Yes X No Hyannis Main Street Waterfront Historic District File# Approved? ❑ Yes X No Listed in National and/or State Register of Historic Places? ❑ Yes X No Previous Site Plan Review File# Approved? ❑ Yes X No Previous Zoning Board of Appeals File# Approved? ❑ Yes X No Is the site located in a Flood Area(Section 3-5.1) ❑ Yes X No In Area of Critical Environmental Concern? ❑ Yes X No Is the Project within 100' of Wetland Resource Area? ❑ Yes X No Site sketch—informal presentation X Yes ❑ No Site Plan prepared,wet stamped and signed by a Registered PE and/or PLS. ❑ Yes X No Parking and Traffic Circulation Plan ❑ Yes ❑ No Landscape Plan and Lighting Plan ❑ Yes X No Drainage Plan with calculations and Utility Plan ❑ Yes X No Building Plans,(all floor plans,elevations and cross sections) ❑ Yes X No Note that all siznage must be approved by Code Enforcement Office at the Building Department Lot area in sq.ft. sq.ft. Total Building(s)footprint sq.ft. Maximum Lot Coverage as%of Lot % GROUND WATER PROTECTION OVERLAY DISCTICT REOUREMENTS: DISTRICT: GP Lot Coverage(%) Required Proposed Site Clearing(%)Required Proposed PRINCIPAL BUILDING ACCESSORY BUILDINGS) ❑ Yes X No Number of floors 2 Height: ft. Number of floors Height: ft. FLOOR AREA: FLOOR AREA: Basement 1500 sq.ft. Second sq.ft. Basement sq.ft. Second sq.ft. First 1500 sq.ft. Attic sq.ft. First sq.ft. Attic sq.ft. Other(Specify) sq.ft. Please provide a brief narrative of your proposed project: Black River Caviar will extend existing Retail business to include other prepackaged foods and expand business operations to caviar repacking The latter will require a commercial kitchen set up(which this location is zoned for) and include limited on-site food prep capabilities for tastingevents vents(only).The Unit is on Septic and Landlord provides under-the-sink grease trap for 3-bay sink 70+%of business operations will be mail order/online fulfillment New location will allow Black River Caviar to develop walk-in Retail business and add repacking operations. In addition to meeting Local and State Health Department requirements the Repacking operation will require HACCP certification and CITES compliance for handlingand repacking caviar. I assert that I have completed(or caused to be completed)this page and the Site Plan Review Application and that, to the best of my knowledge,the information submitted here is true. 24 March,2021 Signature of Applicant Date SARAH MAYO Printed Name of Applicant 0 E T I ----__ PUTMAM.I,murowu*AVENUEit ' a v` ttyy ee \ I I { mob.;,. f ,,• , c +`'-tea t . ` `�� ,: f � I� • � tom/ '. $ ... . .. - ....._ - -- - __ _ ....... t........ �.._n , . .. ...... J Bellaire, Dianna Octv From: Stanton, David Sent: Tuesday, March 30, 20212:31 PM To: Soto, Kathryn Cc: Bellaire, Dianna Subject: Black river caviar 3821 Falmouth Rd FYI, They were on site plan. Will need the following: -Food permit -Variance if not installing a grease trap -Seating- may request a variance from Board,very limited septic capacity available for seating Thanks, Dave 1 j f } Closet f Tail.etMA selling UP ,. � dry fod storage �l � µ S s e.lv T A I STORAGE ROOM R S 'M BASEMENT 3821 FALMOUTH ROAD, 3A, MARSTONS MILLS 02648 R (hallway) pq RETAIL SPACE ENTRANCE UP IREVIIED g S � z� m T u FREEZER A ,����g 20, I `+�Fhb.Ps� ��K,:� s R � FULFILLMENT OFFICE SPACE S aREFR aERpTORI ROOM DOWN HAND WASHING HAND WASHING SINK SINK SEEM R � .. GROUND FLOOR (STREET) MOP & STORAGE GREASE TRAP 3821 FALMOUTH RD, 3A ROOM INTERCEPTOR MARSTONS MILLS, 02648 t i A L A CAR T E M E N U U S T W A N T C A V I A R BLACK RIVER RUSSIAN OSCIETRA CAVIAR -•• � � f �114 Ff' '►�lR4Vllf#*S1 yn E t ter. LACARTE MENU BLACK RIVER RUSSIAN • m v l C,23'LACK(b4IVER�AVIAR ' 500g 250g 100g 50g' 30g 20g SERVINGS(Est per person). SIZE PERSONS IMPERIAL $2,700 s1,350 s540 $270.- $162 . s108 zo 1 g 309 1 TO 2 ROYALE $2,300 $1,150 S460 $230. $138 s92 sog 1 To 3 r 100g 2 TO 4 TRADITION sl,950 s975 s390 s195 S117 s78 250g— - 4 TO.8 500g 8 TO 20 MASTER SELECT Limited quantities. Pricing available upon request. 1000g 20 TO 50 ORDER BY PHONE, EMAIL Ott.-VISIT OUR 0NLI.N.E SHOP PHONE: • • + t y�PQ` ` a a 14* , f li S H A R E P U R E C A V IAR J O Y G I F T S {'_"; _ r �, s:,� �,.ter-� .p � » ��s''1►� r . a. ,�� f TASTE OF CAV I . t 9 Experience Black River's Imperial and Royale grades of Oscietra caviar side-by-side. �[ with BRC's own hand-cut potato chips. Caviar arrives fresh and chilled'in a thermal jar, 4 complete with two Mother-of-Pearl spoons and our caviar tin opener.Simple and special! GIFT SET INCLUDES: 20g IMPERIALOSCIETRA CAVIAR4 4 5300 Vel Black River C��ia'r' Mother-ot-Pearl5poons, A Caviar Tin 0 KZ _ R, • t 350SHIPPINGINCLUDEp GIFT SET INCLUDES: Enjoy our classic Royale Oscietra caviar pairing 50g ROYALE OSCIETRA CAVIAR with lox and Cowgirl Creamery creme fraiche 11 oz Smoked Bluefish S oz Lox °-' on a blini or try a new favorite of Zingerman's 6 of Caviar Cream Cheese ;II 5.3 oz Creme Fraiche Caviar Cream Cheese and smoked bluefish 16 Pack of Blinis 11 topped with caviar. The perfect caviar Mary's Sea Salt Crackers(GF) 2 Mother-of-Pearl Spoons "comfort food"for the festive season. Caviar Tin Opener n 1 G I F T F R I E N D S AND FAMILY THE JOY OF CAVIAR } Black Rivee Caviar gift sets area perfect and easy way to share holiday joy.Gifts ship FedEx Overnight from Monday-Thursday starting November 2 until December 28,2020. Quantity discounts available for Corporate gifting.Please inquire. J ORDER`BY PHONE, EMAIL OR VISIT OUR ONLINE SHOP: 1 PHONE: (774) 238-9851 EMAIL: SALES@a BRCAVIAR.COM WWW.BLACKRIVERCAVIAR.COM w erl ,.. • AY UNIOU ��•..r+w .eye � ., ��ry ( AIL ZZ IRS- 4 �;1' !1 ., LY :• i ?i��+l,� "�y icy, ,,,, j I JXXA� '�, ,\ ( VPCK Vv U LTI MATE CAVIARK V CHEESE & CHARCUTERIE BOARD y' ssA s400 SHIPPING INCLUDED GIFT SET INCLUDES: 1 ,50g TRADITION OSCIETRA CAVIAR Black River's richly intense Tradition Oscietra caviar perfectly accents a hand- 8 oz Lox { 3 oz Bresaola picked selection of all-natural Vermont 3 oz Lonza t r a Salumi cured meats, triple cream Mt. 4 oz Juniper SalumiMt Tam Triple Cream Cheese i Tam cheese from Cowgirl Creamery,and. 6 oz Caviar Cream Cheese. Mary's Sea Salt Crackers(GF) Zingerman's hand-ladled Caviar Cream Black River Caviar Chips Cheese. Choose a chip or cracker and Rustic Flatbread Crackers Caperberries icreate the ultimate gourmet bite! 1 Mother-of-Pearl Spoon +' Caviar Tin Opener GIFT SET INCLUDES : $75 SHIPPINGINCLUDED 50g ' IMPERIAL OSCIETRA CAVIAR _ 6 `�'� �'�' � K' � ♦�,� Y�� For the foodie in your life, Black. River 50g ROYALE OSCIETRA CAVIAR t sends two of our finest Russian Oscietra 11 oz Smoked Bluefish uitto cav`tars, the creamy and unctuous Imperial 3 oz Duck Pr • 3 oz Stagberry Saucaucisson and wonderfully nutty Royale to pair with 6 oz Caviar Cream Cheese r / ' 5.3 oz Creme Fraiche Zingerman's Caviar Cream Cheese, smoked 16 Pack of Blinis r ' bluefish, salty and savory Duck procuitto, Mary's Sea Salt Crackers(GF) r - Black River Caviar Chips and Sta berr saucisson from The Smoking r' r �y ( �. 1 _• Stag berry g Caperberries *' 4 t I If Goose.A myriad of flavor experience awaits 2 Mother-of Pearl Spoons Caviar Tin Opener ,r _ the epicurean palate. YetiTM Rambler Yi Gallon for Caviar ' Aix CELEBRATE THE EXO_UISITE. > SHARE BLACK RIVER. Caviar turns any occasion into a specialN3AS celebration.Black River adds the extra ' excitement of premium Oscietra caviar w�' ACIPEIV cIFT.j� L .� SER A 4 .?�� ��E to the holidays with our exquisite gift y ,�, T,4 ©ENS/qFo� sets brimming with a curated selection r d ' of gourmet delights and Black River's fresh,sustainably-farmed OscietraAgp► yy 71 caviars.Whether you are embellishing a 4 I simple potato chip with a dollop of caviar 4 or putting classic"accoutrements"on a blini with a creamy spoonful of Imperial ? '• ° s j s caviar,our gifts spark delicious pairing conversations and add a generous touch of pure caviar joy to every bite. Celebrate the exquisite.Share Black River. t a LACK I ER AV I A R ' IV . s, it ' � _ HOLIDAYsiSOO SHIPPING INCLUDED iThree grades of Russian Oscietra caviar arrive with a copious selection of accoutrements to + enjoy.Discover how Zin ermans Caviar Cream Cheese and Cowgirl Creamery Creme Fraiche 5� Ko r mq!�,Vw compliment Olympia Provisions cured meats and pates, plus smoked bluefish and lox.This ry assortment invites everyone to share,taste,talk and above all enjoy together. INCLUDES THREE GRADES OF RUSSIAN OSCIETRA CAVIAR: * • �' .m • - +r`----� C - -^;r- _ _ � _' 1[_. ��, °fin 100g IMPERIAL 1100g ROYALE 100g J TRADITION z 11 oz Smoked Bluefish Caperberries Black River Caviar Chips 1 s� 8 oz Lox I IMt.Tam Triple Cream Rustic Flatbread Crackers 4 types of Saucisson Cheese 3 Mother-of-Pearl Spoons 4.2 oz Saucisson Sec 6 oz Caviar Cream Cheese Caviar.Tin Opener 8 oz Pork Rillettes. 5.3 oz Creme Fraiche yetiTM Rambler%Gallon ; a 8 oz Pork and Pistachio 2 x 16 Pack of Blinis for the Caviar r, k Pate Mary's Sea Salt Crackers ` 4 oz Pickled Beets (GF) 5SSO SHIPPING INCLUDED GIFT SET INCLUDES: SOgI MASTER SELECT Master Select is Black River n's rarest and V a OSCIETRA CA IAR most exclusive caviar, representing less 5.3 oz Creme Fraiche 6 than 1% of our production.We recommend 16 Pack of Blinis G Black River Caviar Chips, N enjoying this amber-colored,rich and creamy p 2 Mother-of-Pearl Spoons tr Caviar Tin Opener Oscietra with classic caviar accoutrements, YetiT"Rambler%z Gallon /9r I •� a �'�=� or simply on its own. The intensely complex for Caviar and rich flavors are exceptional and unique to Black River, Limited quantity.- ---